Running head: ST.

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St. Croix Health

Kacy McMurry
University of South Florida

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St. Croix Health
St. Croix is a small island 82.88 square miles in size and is part of the US Virgin
Islands in the Caribbean. It is a quite rural island composed of many mountains, beaches,
and expansive farmlands. There are three main employers on the island, Kmart, Virgin
Islands Paving, and the public school system. Kmart employs 85 people at both of their
stores on the island. The public school system is composed of 16 different schools and
each school has around 80 employees. The other main employer on the island is Virgin
Islands Paving and they employ 80 islanders as well. The island is home to around
50,600 Crucians. The population is made of around 60% Afro-Carrib, 30% Hispanic, and
10% Caucasian. In St. Croix, English is the most common language, with 71.6% of the
population speaking it as their first language, compared to Florida, whose rate of English
as a first language is 73.3%, only a minor difference. Only 50% of the US Virgin Islands
residents have a high school diploma where the rate in Florida is 75.6%. St. Croixs
poverty level is 26.3% where the Florida has a poverty level of 13.3, so St. Croixs is
much higher. The healthcare system in St. Croix is composed of 3 main services, Juan F.
Louis Hospital, Lutheran Services, and Charles Harwood Clinic. Even with these
services, the island has limited resources and oftentimes patients have to be sent to a
different island for care. The objective of this paper is to highlight the strengths and
weaknesses of the community to help provide ideas for a better health care system.
According to Healthy Status 2020, three strengths of St. Croix and the US Virgin
Islands are heart-disease prevention, eating the proper amounts of fruits and vegetables
everyday, and prevention of cancer, especially lung cancer. St. Croix has the lowest rate
of lung cancer in the US as well as having the lowest rate of smokers. They also have the

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lowest rate of deaths from any type of cancer as well. Smoking cigarettes is quite
uncommon in the US Virgin Islands due to the cost. The US Virgin Islands Health
Department placed a smoking ban in all public buildings and several outdoor locations
such as the beaches (ANR, 2011). Creating laws such as the smoking ban creates a
healthier atmosphere for residents. Another strength of St. Croix is that 33.9% of the
population eats the proper amount of fruits and vegetables everyday, which is again
higher than any other state (Healthy Status 2020, 2010). The high consumption of fruit
and vegetable has to do with the high level of agriculture that occurs on the island.
Farmers markets are very popular and make it easy for locals to get fresh produce. The
last strength of St. Croix is that they have the lowest rate of cardiovascular disease in
Black Americans, compared to all US states and territories (Lee et al., 2013). This is
found to be due to better nutrition and lower obesity rates. The level of heart disease is
also lower than most US states overall as well (Healthy Status 2020, 2010).
According to Healthy Status 2020, three weaknesses of St. Croix are its
maintenance and prevention of diabetes, maintaining healthy blood pressure levels, and
access to flu shots. Only 39.8% of the population over the age of 65 received a flu shot in
2010 (Healthy Status 2020, 2010). This has to do with limited health care facilities and
many people believe that the flu shot will cause them to get sick. In the US, an average of
70% of citizens above 65 years of age receive a flu shot, so there is a big differential
between the two. Another weakness is the high level of people with high blood pressure
in St. Croix. 24.8% of residents have high blood pressure in the US Virgin Islands
(Healthy Status 2020, 2010). Many residents think that they can cure high blood pressure
with bush tea, a local drink, which in some cases can help, but many times does not, so

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proper medical care is not found. Health literacy is also very low on the island, so even
when prescribed medication for high blood pressure, it often is not taken properly. The
last weakness is the prevention and maintenance of diabetes. Around 8.7% of the
population has diabetes in the US Virgin Islands, where as in Florida, only 7.7% of the
population has diabetes. The US Virgin Islands have the fourth highest rate of diabetes in
the United States (Healthy Status, 2010). These are the areas that St. Croix and the US
Virgin Islands need to focus on improving.
The priority health issue that is the focus of this paper is the prevention and
maintenance of diabetes. Having one of the highest prevalences of diabetes in the
country is a significant fact. According to AARP Virgin Islands, 74.6% of the population
has never taken a class on how to manage their diabetes. Also found, without any public
health intervention, at least one quarter of Virgin Islanders will end up with diabetes
(AARP Virgin Islands, 2010). Healthy People 2020 is working to help lower diabetes
levels because it affects an estimated 23.6 million people in the United States.
Unfortunately, the Department of Health in the Virgin Islands has poor funding, so it is
almost impossible to have classes educating the public on diabetes. The goal of Healthy
People 2020 is to reduce diabetes and the economic burden of it (HHS Healthy People
2020, 2014).
The determinants of health model creates physical and social environments that
good health for everybody and falls into several different categories such as social
factors, health services, policymaking, biology and genetics, and individual behaviors.
The idea behind this is to be able to create effective interventions easily and to be able to

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think beyond traditional health care factors and include the environment (HHS Healthy
People 2020, 2010).
Factors that affect diabetes are human biology and lifestyle. According to the
CDC, human biology is a factor relating to diabetes. Some people are born not being able
to make insulin, causing a person to be diabetic. This is a factor that people are not able
to change or affect (CDC, 2013). Another factor that affects diabetes is lifestyle because
over time, some people develop diabetes (CDC, 2013). A person may not eat well and
eventually cause diabetes mellitus type 2; this is because of their lifestyle and also
environment if healthy foods are not available. Education also plays into the lifestyle
factor or diabetes.
An appropriate nursing diagnoses based on the data in this paper is: Risk of
developing diabetes in Afro-Carrib individuals living in St. Croix related to poor lifestyle
choices related to nutrition and education as well as human biology and genetics.
The primary level of prevention and maintenance of diabetes is early education
about diet, exercise, and diabetic maintenance. Healthy People 2020 published a goal that
by the year 2020, the number of diagnosed cases of diabetes annually will be reduced
(HHS Healthy People 2020, 2013). To do this, classes need to be available to the public
and awareness needs to be raised in the community. The intervention that needs to take
place is a risk factor modification because many residents of the community will not
know that diet and exercise can effect their chances of developing and taking care of
diabetes. Education will need to be directed towards the community members, but health
care providers and funding sources will need to partake in this intervention. Health care
providers can teach classes or even just inform their own patients about diabetes. These

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classes will need some funding, however. Pamphlets and visual aids as well as the teacher
will need to be provided. The role of the community nurse for this intervention would be
to inform the community of the education available as well as taking part in teaching the
classes. Educating the community about diabetes and prevention and maintenance will
help to decrease the number of new cases annually as well as lower the complications in
individuals who are already diagnosed with diabetes.
The secondary level of prevention is through screening blood glucose levels and
monitoring for pre-diabetic signs and symptoms. The CDC conducted a study from 2007
through 2014 to see if screening for diabetes mellitus type 2 would improve outcomes
and improve treatment options (CDC 2014). This would allow patients to become
educated on pre-diabetes and become aware of the risks and try to prevent the condition
from becoming worse. Screening in the US Virgin islands will be a bit trickier because
not the entire community goes to the doctor. This intervention would be on the individual
level and would consist of screening for diabetes and performing tests. This intervention
would also require the health care provider to come up with a diagnosis and inform and
teach the patient as well as provide any treatment that is needed. The stakeholders that the
intervention is geared towards would be health care providers as well as the patient
because they are affected by this. Health care providers would be the best option for
keeping individuals monitored. The community nurse in this case, would help to perform
the screenings.
The tertiary level of prevention and maintenance of diabetes is maximizing the
quality of life and staying with the course of care strictly. Effective care and treatment
can prevent and or delay complications from diabetes (CDC, 2013). With proper use of

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insulin as well as proper diet and regular exercise can prevent and lower diabetic
complications such as hyperglycemia, obesity, and diabetic ulcers. This intervention
would take part on the individual level because everybodys care will be different.
Compliance with medication as well as diet will need to be monitored. Blood glucose
levels will need to be monitored throughout treatment. By monitoring the patient and
managing the symptoms, it can prevent negative side effects. The health care providers
will be the ones taking part in starting and monitoring the intervention. The community
nurse would be responsible for monitoring compliance and screening.
The idea behind a health policy is to achieve and reach a goal. A health policy
outlines priorities and defines the roles of the stakeholders to change future healthcare
outcomes. In St. Croix, the health policy for diabetes should be based off of primary
prevention. Based on a level appropriate for the entire community, residents should be
educated on the prevention of diabetes as well as maintenance of diabetes. Aimed through
health care providers and funding sources, classes and education material should be given
to the public to help decrease the rate of annually diagnosed cases of diabetes. A health
care provider should teach a class about proper diet and exercise as well as the
importance of screening. The education could also include treatment options and how to
stay healthy even if diagnosed with diabetes. Much of the community lives in poverty, so
funding sources should provide free classes that would be in an area that is easy to access
as well as providing educational pamphlets and flyers at an appropriate reading level to
the community. Schools and health care providers can help to get the word out about the
classes. Educating the children will also help to prevent diabetes from developing.

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Education will be the main way that people of the community can become aware of how
to decrease their risk for diabetes, which would benefit the US Virgin Islands.
In conclusion, diabetes is a large issue in the US Virgin Islands and prevention
and maintenance of diabetes is not being taken care of. There are three levels of
prevention that were discussed in this paper that would help to prevent and manage
diabetes. The primary intervention focuses on education for prevention as well as
treatment options for diabetes. The secondary intervention focuses on pre-screening for
diabetes to help prevent complications. The tertiary intervention focuses on the
management of diabetes after diagnosis and monitoring compliance and side effects. With
the data collected to support these three different interventions, a health policy can be
formed focusing on education to help decrease the annual number of diabetes diagnoses.

References

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AARP Virgin Islands. Managing Diabetes in the Virgin Islands. (May 4, 2010).
Retrieved June 16, 2015, from http://www.aarp.org/health/conditionstreatments/info-05-2010/managing-diabetes-virgin-islands.html
Centers for Disease Control and Prevention. National Diabetes Prevention Program
Florida Department of Health (2014). Retrieved June 16, 2015, from
http://www.floridacharts.com
Healthy People 2020. Determinants of Health. (2014, January 1). Retrieved June 30,
2014, from http://www.healthypeople.gov/2020/about/DOHAbout.aspx
Healthy People 2020. Diabetes. (2014). Retrieved June 16, 2015, from
http://www.healthypeople.gov/2020/topics-objectives/topic/diabetes
St. Croix Foundation. Fact Sheet. (2013). Retrieved June 16, 2015, from
http://www.stxfoundation.org/wp/wp-content/uploads/2013/04/St.-CroixFoundation-USVI-Fact-Sheet.pdf